下肢主要静脉瓣膜的应用解剖及其临床意义研究

发布时间：2018-03-08 05:04

本文选题：下肢静脉　切入点：静脉瓣膜　出处：《重庆医科大学》2008年硕士论文　论文类型：学位论文

【摘要】： 第一部分下肢主要静脉瓣膜的应用解剖学研究目的:通过对150侧成年尸体下肢主要静脉瓣膜的解剖观察,为临床手术治疗提供解剖形态学参考。方法:在150侧成人下肢中,观察、测量并分析大隐静脉、股静脉和乆静脉的瓣膜数量和形状、特别点外径以及某些重要的邻近结构关系。结果:大隐静脉的瓣膜数目为4～15个,平均为7.2个;股静脉瓣膜数量为1～6个,其中以3～4个多见,平均瓣膜数为3.3个;乆静脉瓣膜数量为0～5个,其中,以1～2个多见,有3侧肢体无乆静脉瓣膜,平均瓣膜数为1.8个。股浅静脉第一对瓣膜位置较为恒定,到隐股点距离为(5.45±1.32)cm。大隐静脉、股静脉和乆静脉瓣膜以双瓣型多见,瓣膜分布有越向远侧越多的规律。结论:以上对下肢静脉的观测结果,为临床有关下肢静脉的手术、操作提供了较为系统、全面的解剖学基础。第二部分原发性下肢深静脉瓣膜功能不全的手术治疗分析目的:观察并分析三种常见的深静脉瓣膜重建术治疗原发性下肢深静脉瓣膜功能不全(PDVI)的手术疗效。方法:2005年7月至2007年12月期间我科收治的经下肢顺、逆行深静脉造影,确诊为PDVI的28例患者(36条患肢),根据症状轻重,采用大隐静脉高位结扎及曲张静脉剥脱术、瓣膜环缩戴戒术、腔内深静脉瓣膜修复术以及带瓣静脉段移植术进行手术治疗。用彩色多普勒血管超声检查、CEAP临床分级和临床记分评价所有患肢手术前后的情况,并进行统计学分析。结果:36条患肢术后的临床分级和临床记分均有明显下降,全部患肢手术前、后的临床记分分别为(6.2±3.1)、(2.1±1.5),差异有统计学意义(P 0.01)。12条C2～C3级患肢手术前、后的CEAP临床记分为(2.2±1.1)、(1.1±0.7),有显著性差异(P 0.05)。结论:深静脉瓣膜腔内修复术、瓣膜环缩戴戒术和带瓣静脉段移植术对PDVI的疗效良好。对症状较轻的C2～C3级患肢可单纯采用大隐静脉高位结扎、曲张静脉剥脱术。
[Abstract]:Part I: applied anatomy of the main venous valves of the lower extremities. Objective: to provide anatomic morphological reference for surgical treatment of 150 adult cadavers with main venous valves of lower extremities. Methods: the number and shape of valves of great saphenous vein, femoral vein and human vein were observed, measured and analyzed in 150 sides of adult lower limbs, especially the external diameter of point and some important adjacent structures. Results: the valvular number of great saphenous vein was 4 ~ 15 with an average of 7.2, the number of femoral vein valves was 1 ~ 6, of which 3 ~ 4 were more, the average number of valves was 3.3, and the number of valves of vein was 0 ~ 5, of which 1 ~ 2 was more than 1 ~ 2. The average number of valves was 1.8. The position of the first pair of valves in superficial femoral vein was relatively constant, and the distance to the point of saphenous was 5.45 卤1.32 cm 路cm. The valve of great saphenous vein, femoral vein and human vein were mostly double-valved. The distribution of valves is more and more in the distal direction. Conclusion: the observation results of the lower extremity veins provide a systematic and comprehensive anatomical basis for the operation of the lower extremity veins. The second part: surgical treatment of primary deep venous valve insufficiency of lower extremity. Objective: to observe and analyze the curative effect of three kinds of common deep vein valve reconstruction in the treatment of primary lower extremity deep vein valve insufficiency (PDVI). Methods: from July 2005 to December 2007, 28 patients with PDVI diagnosed by retrograde and retrograde deep vein angiography were treated with high ligation of great saphenous vein and exfoliation of varicose vein according to the severity of symptoms. Valvular ring ring, deep vena cava prosthesis and valvular segment transplantation were performed. The clinical grade and clinical score of CEAP were evaluated by color Doppler ultrasound before and after the operation of all affected limbs. Statistical analysis was carried out. Results the clinical grade and clinical score of 36 affected limbs decreased significantly after operation. Before and after the operation, the clinical scores were 6.2 卤3.1 and 2.1 卤1.5, respectively. The difference was statistically significant before and after the operation of C _ 2C _ 3 grade. The clinical score of CEAP was 2.2 卤1.1 卤0.7, with significant difference (P 0.05). Conclusion: deep vein valve repair, valvular ring ring ring repair and valvular vein segment transplantation have good effect on PDVI. High ligation of great saphenous vein and exfoliation of varicose vein can be used only for C _ 2C _ 3 grade patients with mild symptoms.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R322;R654.3

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